You don’t have to look too far to find frustrating and disparate advice, especially in the world of medicine.
Perhaps one of the more notable cases in recent years involves the rise of probiotic supplements. For many medical providers, both those within the functional medicine focus and outside of it, the advice to add a probiotic supplement to a patient’s daily diet has become the equivalent of telling a Little League player with a skinned knee to “rub some dirt on it”: There may be some who benefit, but most patients will benefit from more comprehensive and well-informed advice.
Gut health and holistic health require more thoughtful treatment than a one-size-fits-all probiotic supplement.
As functional medicine practitioners, it is incumbent upon us to continue to learn, grow, and allow shifting paradigms of optimal patient care to inform our daily practice. How does that apply to probiotics?
As my readers likely understand, probiotics are live microorganisms that are marketed under claims of improving digestive health and overall health. Unfortunately for our patients, these claims are rarely substantiated by peer-reviewed studies. Gut health and holistic health require more thoughtful treatment than a one-size-fits-all probiotic supplement.
Why the Traditional Probiotics Model Doesn’t Work
When a new patient walks in the door of the average medical practitioner’s office, they often arrive with certain specific health concerns. When any of their concerns are for weight management or digestive system issues, the first question they often hear is about what probiotic foods or supplements they are consuming. Patients considering themselves in good health and seeking regular check-ups are also likely to tell their providers that they are regularly taking probiotics.
For years, the common model has been to recommend a daily probiotic to boost the healthy bacteria within the digestive system. Thanks in part to the increasing awareness of the connection between gut health and skin health, brain health, mental health, and immune system health, the idea of boosting those beneficial bacteria is certainly appealing. However, according to Scientific American, probiotics may have limited effectiveness in helping your patients reach their health goals.
No matter how powerful a probiotic or how packed with CFUs, there is no conclusive evidence that a probiotic offers enough benefit to be a general recommendation.
Probiotics have traditionally been recommended for myriad health concerns, including
- Digestive health
- Irritable bowel syndrome (IBS)
- Asthma
- Crohn’s disease
- Antibiotic-associated diarrhea and digestive distress
- Vaginal yeast infections
- Weight management
- Skin health
Simply looking at the variety of health concerns that are supposed to be impacted by a simple probiotic supplement, it may seem unbelievable that there could be a “magic pill” that would reliably impact all these conditions. While the rising interest in the human microbiome is encouraging to functional health providers seeking to help their patients to a lifestyle of enduring and holistic health, the skepticism of probiotics is well warranted.
That is not to say that probiotics have no impact or do not have their uses.
There is some promising research that shows probiotics offer some relief of symptoms for young children with antibiotic-associated digestive distress. Additionally, probiotics do reportedly offer some support for those with IBS, but even the research into IBS sufferers has been clear that while probiotics help some study participants significantly, it has little to no impact for others.
This appears to be a clear indication that the same treatment does not benefit even patients with the same condition equally. No matter how powerful a probiotic or how packed with CFUs (colony-forming units), there is no conclusive evidence that a probiotic offers enough benefit to be a general recommendation.
In this video, I explain why probiotics aren’t all they are marketed to be.
The Difference Between a Diverse Gut Microbiome and a Probiotic Pill
The microbiome encompasses an estimated 100 trillion microbial cells and viruses—more than triple the average number of human cells in the body—and the majority of the microbiome is concentrated in the gut. These microorganisms, including viruses, archaea, bacteria, and eukaryotes, serve a variety of functions in the body.
Most notably, the more diverse the gut microbiome, the more likely a patient will experience fewer chronic health issues, have a stronger immune system response to harmful pathogens, and experience resilience against mental health disruptions.
Imbalances or deficiencies in the gut microbiome, dysbiosis, IBS, and leaky gut do not appear the same way twice, and the road to a diverse microbiome is as different as the patient in your office is from the patient before them.
The question is not “what probiotic is best for leaky gut” but “what is the most effective treatment path for this specific patient with leaky gut?”
The mechanism behind the dysfunction may be an overgrowth of a specific bacteria or the absence of another. In fact, a 2019 study reported in ScienceDirect found that the ability of bacteria to evolve in the gut may mean there are beneficial probiotics adapting in ways that are actually harmful to their host.
Even the most well-meaning probiotic producers, creating thoughtfully made and carefully cultivated products, cannot guard against live cultures evolving, nor can they adequately address the need for individualized approaches to diversifying gut bacteria in a broad population. Therefore, the question is not “what probiotic is best for leaky gut” but “what is the most effective treatment path for this specific patient with leaky gut?”
Functional Wellness Beyond Probiotics
No matter what concern brings a new patient to your office, a conscientious practitioner knows there is no magic bullet and begins with a thorough exam and workup to learn the mechanism behind their patient’s distress.
Once you understand what is causing your patient’s condition, you can develop and initiate a customized treatment plan that goes beyond tossing endless probiotics, digestive enzymes, and elimination diets at your patient with limited effectiveness and growing frustration. An adult patient with Crohn’s disease is going to benefit from a substantially different approach than a child with antibiotic-induced diarrhea.
Standard GI protocols too often leave patients high and dry without seeing any meaningful improvements. You owe it to your patients to look beyond generic treatment plans and provide personalized care. But how?
When you sign up for Dr. Datis Kharrazian’s free half-hour mini-training session, Mastering Complex Gastrointestinal Cases, you’ll learn four game-changing clinical insights to revolutionize how you approach patient care.
New Kharrazian Institute members can also watch the first module of Dr. Kharrazian’s full 12-hour Gastrointestinal Clinical Strategies course free with their 7-day free trial.
Start creating truly personalized GI treatment strategies that work. Sign up today!
Standard GI protocols too often leave patients high and dry without seeing any meaningful improvements. You owe it to your patients to look beyond generic treatment plans and provide personalized care. But how?
Research from multiple sources, including UC Davis, Vanderbilt University Medical Center, and Washington University in St. Louis, indicates that far more important than introducing more microbes to the digestive tract, nourishing the healthy bacteria and maintaining both diversity and balance are keys to managing symptoms of a broader variety of health concerns.
Even then, each patient you see will require an individualized treatment plan. However, this information allows us to shift our focus to how best to nourish the healthy and diverse microbiome rather than wasting time, money, and effort trying to introduce new microbes to the environment of our patient’s gut. In fact, a diverse microbiome has been linked to longevity and self-reported vitality in aging populations.
How, then, do we guide our patients to nourish and maintain microbiome diversity?
By now, you have hopefully seen that there is no single answer, but when choosing how to focus, the first things that rise to the top are fiber, dietary diversity, and more fiber. We are not talking about a gritty fiber supplement mixed in water and chugged at the end of the day.
When you work closely with your patients to discover the diet that will allow them to thrive while feeding the microbiome, you will see better patient outcomes.
Rather, we are talking about rediscovering the rainbow of fruits and especially vegetables that are available and prioritizing these in the diet.
The healthy microbes in the gut absolutely thrive on the dietary fiber we get from vegetables, and to a lesser extent fruit, allowing them to proliferate. Amazingly, in those cases where a probiotic is deemed beneficial, a diet rich in fiber will create a more hospitable environment for it, though a probiotic certainly cannot replace fiber.
Additionally, cultured foods have prebiotic and probiotic properties that can be beneficial when included as part of a varied diet that is heavily leaning towards fiber-rich vegetables and foods. Kefir, kombucha, kimchi, sauerkraut, and even yogurt are all examples of foods that may have a place in your patients’ diets as they create lifestyles meant to nourish that diverse microbiome.
When you work closely with your patients to discover the diet that will allow them to thrive while feeding the microbiome, you will see better patient outcomes.
How to Treat Gastrointestinal Patients Efficiently and Effectively
The traditional model of treating any and all digestive complaints, along with a host of other medical concerns, with probiotics and supplements and hoping for good outcomes is not the appropriate standard of patient care for reputable functional medicine practitioners. The risk of oversimplifying digestive and other health issues is that we will be holding our patients hostage in their suboptimal health when we could be enabling and empowering them to take control of their health. Continually moving toward a more holistic model and shifting our thinking as we learn more about the beautifully complex body and how best to care for it are necessities if we are to serve our patients and communities well.
When you join my online course, you’ll gain the necessary knowledge to treat GI patients effectively and efficiently.
When you join my online course, Gastrointestinal Clinical Strategies and Treatment Applications, you’ll gain the necessary knowledge to treat GI patients effectively and efficiently. This groundbreaking course is based on my 20+ years of experience working with patients, breakthrough scientific research, and time-tested clinical strategies that I’ve used in my own practice with enormous success.
I’ll show you a step-by-step approach to diagnosing the underlying mechanisms of gastrointestinal dysfunction and developing customized treatment strategies that work.
By the end of this course, you’ll have a time-tested clinical model you can immediately use to help your current patients quickly return to optimal GI health.
If this sounds like a next step you’d like to take, click here to learn more.
